The Psychosomatic Secret

The unscientific allure of mind-body medicine.

Big ideas about how the mind can make the body sick—or, better, can cure it of disease—have caught on throughout American history, spread by scores of best sellers, some medical writing, some magical thinking, and at least one Broadway song. In the 1940s and '50s, physician and psychoanalyst Franz Alexander argued that repressed emotions can cause specific disorders like ulcers, asthma, and hypertension. In 1950, the Broadway musical Guys and Dolls joked that matrimonial frustration is bad for the upper respiratory tract. In 1960, after Norman Mailer stabbed his wife with a penknife, he claimed that so much rage, if repressed, would have caused cancer.

Each decade has also brought fresh claims that laughter or self-knowledge or love or positive thinking can cure the body of particular ills. In the 1970s, writer Norman Cousins described how megadoses of the Marx Brothers and other comedies cured him of a severe form of arthritis. In the 1980s, physician Bernie Siegel set up a treatment program that counseled cancer patients to reassess their lives and become "exceptional" in order to survive the disease. In the 1990s, journalist Bill Moyers featured ancient Chinese remedies alongside home-grown ones in a PBS series that helped make mind-body medicine the publishing bonanza it remains. But as book has piled upon book, expert upon expert, guru upon gimmick, the whole messy realm has cried out for a rigorous, cultural cartographer.

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It has found one, finally, in Anne Harrington. A Harvard historian, she has expertly mapped the transmission of mind-body ideas in The Cure Within, showing us where they come from and why exactly they seem to have nine lives. That mind-body medicine has provoked influential skeptics to speak out against it hasn't checked its growth. In the late 1970s, Susan Sontag famously attacked the belief that character causes disease. "Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it," she wrote in Illness As Metaphor. Marcia Angell, then an editor at the New England Journal of Medicine, echoed the fear that patients swept up in psychologizing would feel "the anguish of personal failure" if they couldn't cure themselves and might even "come to see medical care as largely irrelevant." Yet the mind-body message continues to thrive.

Harrington does not neglect the dangers it poses. In fact, she turns up the most alarming anecdote I have ever heard: a doctor who tells an anguished mother that "every child with cancer is an unloved child." (A close second is the feminist writer and physician who insists that miscarriages are related to inner conflicts about motherhood.) Still, Harrington is a surveyor, not a critic, and follows the slip and tumble of ideas with matter-of-factness. At the root of many mind-body notions she finds religious belief, "imperfectly secularized." The belief that priests could exorcise demons from the body set the stage for the idea that physicians could expunge disease through the power of suggestion. With psychoanalysis thrown into the mix (along with military medicine and a rash of cultural anxieties), patients' own power to purge the demons—through self-knowledge or will or positive thinking—gained traction in the 20th century.

This approach was fueled by disgust with medical arrogance and authority, especially in the 1970s. Today, in a more sophisticated synthesis of mind-body ideas, the belief that empathetic doctoring can heal—in part through the placebo effect of a medical presence—has gained ground. Perhaps it's the stringencies of managed care, Harrington suggests, that have renewed our appreciation for the psychological, not just medical, clout of white coats. "We still believe in positive thinking, but many of us also think it would be nice if our doctors were part of the formula." On Harrington's map of this fascinating landscape, you'll find the secrets of mesmerism and hypnotism, the resilience of Mary Baker Eddy, the can-doism of TheLittle Engine That Could, and other cultural signposts. Crucially, she shows that "in no instance" did ideas of mind-based healing emerge first as "self-contained bodies of expert knowledge." Rather, they sprang from religion or culture, and persisted partly by shape-shifting and slipping back and forth between medical and popular realms.

Of course, many of these ideas have not stood up to scientific scrutiny. Theories about how disease is caused by the mind have often served, in fact, as "an index of how much is not understood about the physical terrain of a disease," as Sontag put it. Better science has undermined the notion that stress causes ulcers, that unresolved dependency triggers asthma, and that Type A personalities lead to heart attacks. It has also undercut the myth that emotionally frigid "refrigerator mothers" are responsible for their children's autism.

Science hasn't succeeded in ratifying many well-hyped mind-based treatments for cancer and heart disease, either. Studies have repeatedly failed to find life-extending benefits in positive thinking, though they've hinted that managing negative thinking may sometimes be useful. For instance, in the late 1990s, research showed that breast cancer patients with a "fighting spirit" did not have better five-year survival rates, though feelings of helplessness and hopelessness were associated with worse outcomes. In 2001, a randomized trial found that supportive group therapy did not extend life for women with metastatic breast cancer. And this October, researchers also failed to demonstrate any link between emotional well-being and survival for patients with head and neck cancer. Meanwhile, for heart patients, treatment to reduce feelings of isolation and depression did not lower the odds of a second heart attack, a 2001 study found. Given these failures, it's easy to view mind-based treatments, especially for cancer patients, as all side effect and no cure.

But Harrington inspires a more generous view. At least some studies have shown that group therapy for cancer patients can improve mood and reduce pain. And the drumroll for therapy and social support has probably encouraged cancer programs and clinicians to pay more attention to emotional issues and quality of life. That's a good thing whether or not it increases life span. And when all is said and done, the side effects of positive thinking still pale in comparison with those of some medical interventions for cancer that also turned out not to work. Next to, say, high-dose chemotherapy for breast cancer, which brought patients to the brink of death, forced optimism as a failed experiment doesn't really seem so bad.

Ultimately, mind-based remedies will have specific, limited successes—just as other medical interventions do. The placebo effect may not cure many diseases, but it does seem to reduce some kinds of pain. Massage therapy appears to reduce acute pain after major surgery. And certainly, for psychiatric conditions like depression and anxiety, cognitive behavioral therapy is often successful. Research that treats the mind simply as a phenomenon of the brain—and looks for neural and biochemical explanations for apparent effects, as well as mechanistic links between the brain and the rest of the body—will yield the most credible and medically useful results. Even if no one sings about it on Broadway.